Caring for pregnant individuals with complex medical, obstetrical or fetal diagnoses is a challenge for providers, but early identification and application of a multidisciplinary care model can optimize outcomes.
Christina Han, MD, Associate Clinical Professor of Obstetrics and Gynecology and Division Director of Maternal-Fetal Medicine, is making it a priority for the high-risk obstetrics service to streamline collaborations with experts across the UCLA Health system to improve care for women with complex pregnancies, from pre-conception to pregnancy to the postpartum period. Dr. Han joined the faculty of UCLA’s Department of Obstetrics and Gynecology in October, and is currently building multi-disciplinary programs for cardio-obstetrics, diabetes in pregnancy, preconception care, and advanced prenatal diagnosis and genetic screening.
For those individuals with heart disease who desire pregnancy or are pregnant, UCLA relies on a collaborative approach to care with experts in maternal-fetal medicine, adult cardiology, pediatric cardiology, anesthesiology, neonatology, nursing, and mental health. These teams work together to provide specialized care in the most complicated scenarios, often with joint counseling sessions and multidisciplinary meetings. Yalda Afshar, MD, PhD, Assistant Professor and maternal-fetal medicine specialist in Obstetrics and Gynecology at UCLA, was recently an integral part of a large, multidisciplinary team of specialty providers coordinating care for a mother with pulmonary hypertension at 25-weeks gestation. UCLA’s top specialists from multiple departments came together to coordinate this extremely high-risk, but successful, undertaking to deliver a healthy baby in the intensive care unit. "When the family decided that they were going to continue with the pregnancy, we were ready," said Dr. Afshar. The story was featured on KABC-TV, and is just one example of the quality care provided by the UCLA high-risk obstetrics service.
Committed to being at the forefront of science, our maternal-fetal medicine specialists are also committed to advances in research and education. At the helm, Deborah Krakow, MD, Chair of Obstetrics and Gynecology and Professor of Obstetrics and Gynecology, Orthopedics and Human Genetics at UCLA, currently holds a PO1 and R01 aimed at identifying genes and molecular basis for recessive chondrodysplasias and musculoskeletal disorders.
Carla Janzen, MD, PhD, Associate Professor and Maternal-Fetal Medicine specialist in Obstetrics and Gynecology at UCLA, is part of a team of researchers spearheading a study to identify complications of pregnancy utilizing free-standing genetic material shed from the placenta into the mother’s blood. The team’s effort to advance knowledge about the placenta and maternal health will hopefully guide further development of tests to help diagnose pregnancy disorders earlier.
The Division of Maternal-Fetal Medicine is also actively involved in the University of California Fetal Consortium, a transdisciplinary collaboration among the five University of California medical centers aimed at optimizing maternal, fetal, and neonatal outcomes. Our experts and trainees in Maternal-Fetal Medicine and Pediatrics contribute to the Consortium by leading and participating in projects aimed at training, clinical research, and quality improvement initiatives.
Another priority for Dr. Han is to build an enhanced portfolio of clinical trials to improve outcomes for women with complex pregnancies. UCLA Obstetrics and Gynecology is currently recruiting pregnant subjects for prospective clinical trials in COVID-19, mental health disorders, and thromboprophylaxis, with additional clinical trials in the pipeline.
Coronavirus Outcomes in Mother-infant Pairs (COMP) is a prospective observational study evaluating clinical outcomes, viral shedding and development of immunity in mother-infant pairs affected by COVID-19. Rashmi Rao, MD, Health Sciences Clinical Assistant Professor, is co-principal investigator on this project. Dr. Rao is also leading the Heparin Dosing for Antepartum Hospitalizations (HEPDOSE) trial that aims to assess the effect standard dosing versus gestational age-based dosing of unfractionated heparin has on receipt of neuraxial anesthesia as well as to evaluate the pharmacokinetics and pharmacodynamics of unfractionated heparin in pregnancy.
PRIORITY (Pregnancy CoRonavirus Outcomes RegIsTrY) is a nationwide study of pregnant or recently pregnant women who are either under investigation for Coronavirus infection (COVID-19) or have been confirmed to have COVID-19 to help patients and doctors better understand how COVID-19 impacts pregnant women and their newborns. Dr. Afshar is a co-principal investigator on this study, along with a team of co-PIs from UCSF.
The New Moms Study, a prospective cohort study aiming to determine efficacy of standard versus technology-based mental health treatment during pregnancy, is led by Misty Richards, MD, MS, Assistant Clinical Professor of UCLA Obstetrics and Gynecology and UCLA Division of Child and Adolescent Psychiatry and Medical Director of Perinatal Psychiatry, and Dr. Rao, who is also the Obstetric Medical Director of Mental Health. This interdisciplinary team also heads the Maternal Outpatient Mental health Services (MOMS) Clinic serving the mental health needs of women during the perinatal period.
Dr. Han’s vision is “to expand on the strong foundations of our division to build a world-class Maternal-Fetal Medicine program that delivers compassionate and evidence-based patient care, performs cutting-edge innovative research, and trains a strong cohort of future Maternal-Fetal Medicine leaders.”